| Objective:The aim of this study is to analyze the clinicopathological features and prognostic factors of stage Ⅱ endometrioid carcinoma,and to evaluate the effect of hysterectomy type and adjuvant therapy on the prognosis of stage Ⅱ endometrioid carcinoma.Method:The clinicopathological data of 124 patients with stage Ⅱ endometrioid carcinoma who were primary treated at the Cancer Hospital of Chinese Academy of Medical Sciences from January 1995 to October 2017,were retrospectively analyzed.The influence of related clinicopathological factors affecting the prognosis of stage II ECa were explored.And these patients was divided into three groups by the size of cervical infiltrating tumors:group A-cervical invasion diagnosed by microscope,group C-cervical tumor length>2cm,group B-cervical tumor size between group A and C.The clinicopathological features,treatment methods and prognosis were compared and analyzed between the three groups.Result:The 5-year disease-free survival rate of 124 patients with stage Ⅱ endometriod carcinoma was 90.2%,and the 5-year overall survival rate was 93.0%.Hysterectomy type and adjuvant radiotherapy were indentified as the influencing prognostic factors for DFS and OS by univariate analysis.The 5-year DFS and OS of the patients who underwent radical hysterectomy were significantly superior to those extrafascial hysterectomy(94.2%vs 79.3%,97.2%vs 81.6%),and the 5-year OS of patients who received adjuvant radiotherapy was superior to those without(97.2%vs 81.6%),P<0.05.The type of hysterectomy was confirmed as the independent prognostic factor by multivatiate COX regression.According to multivariate analysis,histological grade 3 was associated with DFS(hazard ratio,1.843;P=0.051),and positive PR was associated with OS(hazard ratio,0.109;P=0.088).Among the three types of cervical infiltrating tumor,there were differences in histological grade and depth of myometrium infiltration.The proportion of high grade lesions and deep myometrium infiltration in group C was significantly higher than that in group A.The detective rate of MRI using to evaluate the cervical involvement of group B and C were significantly higher than group A.And the proportion of radical hysterectomy in group C was higher than that in group A,P<0.017.The survival analysis showed that there was no significant difference in DFS and OS between different groups.However,the DFS and OS of those patients who received radical hysterectomy were significantly better than that of the patients who underwent extrafascial hysterectomy,in group A.The OS of the patients who received adjuvant radiotherapy was increased significantly,in group B and C.Conclusion:The prognosis of stage Ⅱ endometrioid carcinoma is related to histological grade and PR expression.The disease-free survival and overall survival of radical hysterectomy is better than that of external fascia hysterectomy.Radical hysterectomy is recommended for patients who suspected or gross cervical involvement before operation,and adjuvant radiotherapy can improve survival.Objective:To analyze the clinical features of stage IA1 cervical cancer and to evaluate the efficacy and safety of cold knife conization.Method:The clinical data of 74 patients with stage IA1 cervical cancer who were treated with initial cervical cold knife conization(CKC)were retrospectively analyzed,and the clinical characteristics,prognosis,and fertility were evaluated.Result:The pathological results of preoperative cervical biopsy under colposcopy for the 74 patients indicated that,35 cases(47.3%)had microinvasive cervical carcinoma,while no infiltrative lesions were observed in 13 cases after CKC;there were 39 case(52.7%)of stage IA1 cervical cancer.The pathological diagnosis after CKC showed that,35 cases(47.3%)had multifocal infiltrations,while 39 cases(52.7%)were with unifocal infiltration;62 cases(83.8%)had infiltration depth<2 mm;2 cases(2.7%)were with lymphatic vascular space invasion.The median follow-up time in this group of patients was 70.3 months,and 5-year recurrence-free survival rate was 95.1%,with an overall survival rate of 100%,among these subjects,2 cases had recurrence(one relapsed with general multiple lymph node metastasis in 5 and a half years after CKC and received chemotherapy,and the other one was with pelvic recurrence in 3 years after surgery and was administered with concomitant radiochemotherapy).Of the 74 patients,64 patients(86.5%)developed the disease at or before 45 years old,and 6 patients among them were with spontaneous pregnancy,but only 3 of them finished their labor(1 had full-term spontaneous labor,1 with full-term cesarean section,and 1 had preterm labor),while the other 2 patients underwent artificial abortion,and 1 was administered with curettage due to embryonic diapause.Conclusion:CKC is a safe and effective treatment for fertility or uterus sparing for patients of stage IA1 cervical cancer.The depth of infiltration may be associated with postoperative recurrence/metastasis,but these factors,including infiltrative state(multifocal/unifocal infiltration),lymph vascular space invasion,are not related to the recurrence and/or metastasis after surgery.The close long-term postoperative follow-up is essential. |
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